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145 Cards in this Set
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decreased serum iron
increased TIBC decreased ferritin |
Iron deficiency anemia
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decreased TIBC (total iron binding capacity),
increased ferritin increased iron stores in marrow macrophages |
anemia of chronic disease
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decreased serum haptoglobin
increased serum LDH |
RBC hemolysis
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increased transferrin/TIBC
decreased percent transferrin saturation |
Anemia of pregnancy/Oral Contraceptive use
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increased serum iron
decreased transferrin/TIBC increased ferritin big increase in %transferrin saturation |
hemochromatosis
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severe anemia requiring transfusions
cardiac failure due to secondary hemochromatosis marrow expansion |
beta thalassemia major
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severe anemia requiring transfusions
cardiac failure due to secondary hemochromatosis marrow expansion |
beta thalassemia major
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increased serum bilirubin
jaundice pigment gallstones increased reticulocytes |
hemolytic anemais
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intrinsic, extravascular hemolysis
small, round RBCs with no central pallor increased MCHC increased RDW Howell-Jolly bodies after splenectomy |
hereditary spherocytosis
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increased PT,
increased PTT, increased fibrin split products (D dimers) decreased platelet count helmet-shaped cells and schistocytes |
DIC
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platelet count down
bleeding time up normal PT and PTT |
thrombocytopenia, or
Bernard-Soulier Disease |
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PTT up
normal platelets, bleeding time and PT |
hemophilia A or B
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increased bleeding time and PTT
normal PT and platelet count |
von Willebrand's disease
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platelet count down
bleeding time up PT up PTT up |
DIC
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PT up
PTT up normal platelet count and bleeding time |
Vitamin K deficiency
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bleeding time up
platelets, PT and PTT all normal |
Glanzmann's thrombasthenia
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localized single group of nodes (rarely extranodal)
low grade fever, night sweats, weight loss mediastinal lymphadenopathy 50% chance of associated EBV likely young or old |
Hodgkin's lymphoma
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HIV or immunosuppression
multiple peripheral nodes involved extranodal common noncontiguous spread no hypergammaglobulinemia few constitutional symptoms 20s-40s |
non-Hodgkins lymphoma
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few Reed Sternbergs
3+ lymphos collagen banding lacunar cells likely young and female |
Nodular sclerosing Hodgkins with excellent prognosis
= most common type |
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4+ Reed Sternbergs with 3+ lymphocytes
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Mixed cellularity Hodgkins with intermediate prognosis
25% of Hodgkins |
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few Reed Sternbergs with 4+ lymphocytes
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Lymphocyte predominant Hodgkins with excellent prognosis (males under 35)
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Older male with disseminated disease
Reed Sternbergs higher than lymphocytes 1+ lymphocytes |
Lymphocyte depleted Hodgkins with poor prognosis (rare, older males with disseminated disease)
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fried egg plasma cell
high IgG or IgA over 40 hypercalcemia renal insufficiency monoclonal immuoglobulin spike on serum electrophoresis Ig light chains in urine rouleaux RBCs symptomatic |
Multiple Myeloma
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fried egg plasma cell
high IgG or IgA over 40 hypercalcemia renal insufficiency monoclonal immuoglobulin spike on serum electrophoresis Ig light chains in urine rouleaux RBCs asymptomatic |
MGUS - monoclonal gammopathy of undetermined significance
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B cell lymphoma
adult focal mass like CLL low grade |
small lymphocytic lymphoma (non-Hodgkins)
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B cell lymphoma
adult t(14;18) bcl 2 expression indolent |
Follicular lymphoma (small cleaved cell) - Non Hodgkins
difficult to cure, but indolent |
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older adult (but 20% kids)
B cell (80%) and T cell (20%) lymphoma aggressive |
Diffuse large cell lymphoma (non-Hodgkins)
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adult
B cell lymphoma t(11;14) CD5+ |
Mantle cell lymphoma (non Hodgkins)
poor prognosis |
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children
T cell lymphoma ALL often accompanies mediastinal mass |
Lymphoblastic lymphoma
(non-Hodgkins) |
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children
B cell lymphoma t(18;14) c-myc gene moves to next to heavy-chain Ig gene (14) Starry sky associated with EBV jaw lesion in endemic form in Africa pelvis or abdomen in sporadic form |
Burkitt's lymphoma
(non-Hodgkins) |
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WBCs in blood up
bone marrow, liver, spleen infiltrates anemia due to marrow failure infections hemorrhage |
Leukemia
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children
lymphoblasts TdT+ mets to CNS and testes |
ALL
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Auer rods
myeloblasts adults |
AML
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older adults
lymphadenopathy hepatosplenomegaly few symptoms indolet course increased smudge cells in peripheral smear warm antibody autoimmune hemolytic anemia like SLL |
CLL
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t(9;22)
bcr-abl myeloid stem cell proliferation PMNs up metamyelocytes up splenomegaly blast crisis v low leukocyte alk phos |
CML
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left shift (80% bands)
leukocyte alk phos up |
leukemoid reaction
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mature B cell tumor
elderly cells with filamentous, hair-like projections Stains TRAP+ |
Hairy cell leukemia
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young smoker
Birbeck granules |
Histiocytosis X
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severe anemia
neutropenia thrombocytopenia fatigue malaise pallor purpura mucosal bleeding petechiae infection hypocellular bone marrow with fatty infiltration |
aplastic anemia
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hilar mass arising from bronchus
cavitation smoker PTH like activity keratin pearls (histology) intercellular bridges (histology) lesion is central |
Squamous cell carcinoma
(Squamous, Ssentral Smoking) |
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in site of prior pulmonary inflammation/injury
most common in nonsmokers and females no smoking link multiple densities on CXray Clara cells to Type II pneumocytes lesion is peripheral |
Adenocarcinoma
2 kinds: bronchial and bronchioloalveolar. The latter is not linked to smoking |
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ectopic production of ACTH or ADH
can lead to autoantibodies to Ca channels (Lambert Eaton) Responsive to chemo Neoplasm of neuroendocrine Kulchitsky cells (small dark blue) central lesion |
small cell (oat cell) carcinoma
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highly anaplastic undifferentiated tumor
ppor prognosis less metastasis less responsive to chemo pleomorphic giant cells with leukocyte fragments in cytoplasm |
Large cell carcinoma
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secretes serotonin
possible flushing, diarrhea, wheezing,salivation |
carcinoid (syndrome if also in liver)
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mets in brain, bone and liver
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metastatic lung cancer
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carcinoma in apex of lung
Horner's |
Pancoast tumour
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cough hemoptysis
bronchial obstruction wheezing "coin" lesion on xray |
lung cancer
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autoantibldy production
destruction of platelets overactivation of remaining platelets thrombocytopenia hypercoagulability |
Herparin-induced thrombocytopenia (HIT)
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ause of iron deficiency anemia
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impaired heme synthesis
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cause of pernicious anemia
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autoimmune gastritis -
vitamin B absorption failure - delayed DNA replication |
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cause of folate deficiency anemia
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delayed DNA replication
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cause of aplastic anemia
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greatly diminished hematopoiesis
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cause of myelophthisic anemia
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bone marrow replacement, usually by malignant tumor
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hypochromia
microcytosis decreased serum iron increased TIBC decreased serum ferritin pallor, fatigue, DOE |
iron deficiency anemia
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hypersegmented PMNs
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pernicious anemia
folate deficiency |
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achlorhydria
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pernicious anemia
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absent position and vibration sensations
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vitamin B12 deficiency and therefore pernicious anemia
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hyperreflexia
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vitaimin B12 deficiency and therefore pernicious anemia
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Schilling test
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used to diagnose pernicious anemia
if giving intrinsic facor corrects the impaired vitamin B12 absorption then you have pernicious anemia |
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pancytopenia
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pernicious anemia, folate deficiency and aplastic anemia
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Cause of diminished hematopoiesis in aplastic anemia
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toxic drugs and chemicals
often idiopathic |
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diseases related to anemia of chronic disease
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RA
renal disease chronic infection (e.g., TB) |
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marked hypocellularity of bone marrow
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aplastic anemia
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pancytopenia
oval macrocytes hypersegmented neutrophils |
pernicious anemia
folate deficiency aplastic anemia |
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megaloblastic anemia
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pernicious anemia
folate deficiency |
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hypocellularity of bone marrow
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aplastic anemia
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most often normochromic and normocytic or macrocytic
but may be hypochromic an dmicrocytic with decreased serum iron and decreased serum iron-binding capacity |
anemai of chronic disease
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small numbers of nucleated red cells and immature granulocytes in the peripheral blood
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myelophthisic anemia
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anemia associated with tumor cells in the bone marrow
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myelophthisic anemia
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lemon yellow skin color
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pernicious anemia
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subacute combined degeneration of the spinal cord: what is it associated with
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pernicious anemia, and associated:
hyperreflexia extensor plantar reflexes ataxic gait impaired position and vibration sensation |
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anti-intrinsic factor antibodies
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pernicious anemia
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fatigue
atrophic glossitis pica koilonychia (nail spooning) esophageal web |
iron deficiency
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smooth tongue
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pernicious anemia
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skin darkening
endocrinopathy liver damage cardiac damage |
hemochromatosis
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low serum iron
high transferrin low ferritin |
Iron Deficiency anemia
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low serum iron
low transferrin high ferritin |
anemia of chronic disease
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elevated soluble transferrin receptor
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iron deficiency anemia
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hypersegmented neutrophils
pancytopenia reticulocytopenia elevated LDH normal or elevated serum FE low B12 or folate |
megaloblastic anemia
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megaloblastic anemia
glossitis/stomatitis GI malabsorption secondary to impaired GI |
folate deficiency
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achorhydria
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pernicious anemia
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immune disease that pernicious anemia is associated with
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Hashimoto's thyroiditis
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dementia
demyelinating disease loss of posterior and lateral columns in subacute combined degeneration |
cobalamin deficiency
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increased homocysteine and methylmalonic acid
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B12 deficiency
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dietary B12 deficiency
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severe anorexia
strict veganism |
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microcytosis
no anemia |
beta thalassemia trait
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CD 59 (DAF) positive and CD 55 positive
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hereditary spherocytosis - hemolytic anemia
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positive HAM (acid hemolysis
reddish black morning urine CD 59 and CD 55 negative |
paroxysmal nocturnal hemoglobinuria - hemolytic anemia
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Heinz bodies and bite cells
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G6PD deficiency hemolytic anemia
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empty bag red blood cells
alpha hemoglobin aggregations |
beta thalassemia major
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positive direct coombs test
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immune hemolytic anemia with Ig on RBC surface
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Indirect Coombs test
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Immune hemolytic anemia with antibodies in the serum
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patient who had taken quinidine, quinine or isoniazid has anemia
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Immune complex mechanism - Rx induced Immune Hemolytic anemia
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Patient who had taken penicillin or cephalosporin has anemia
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Haptenic mechanism - Rx induced immune hemolytic anemia
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patient who had taken methyldopa, l dopa, procainamide, ibuprofen has anemia
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Autoimmune mechanism - Rx induced immune hemolytic anemia
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patient transfused and immediately died
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Immediate intravascular hemolytic transfusion reaction
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patient transfused after prior transfusions and develops mild anemia over several days
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slow extravascular form of hemolytic transfusion reaction
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patient asymptomatic after a transfusion and it takes weeks for any evidence of anemia
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delayed form of hemolytic transfusion reaction
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patient who had another illness developed an anemia with IgG antibodies present. (And how to treat it?)
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warm type autoimmune hemolysis
treat with steroids/splenectomy |
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patient has an IgM mediated anemia. Agglutination only at < 30 degrees. (And how to treat?)
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cold type autoimmune hemolysis.
Treat with plasmapharesis |
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low serum ferritin
low transferrin saturation low serum iron increased transferring |
iron deficiency anemia
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microcytic
hypochromic anisocytosis poikilocytosis |
iron deficiency anemia
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moderate Hgb
EPO slightly elevated decreased serum iron decreased transferrin all other counts normal |
anemia of chronic disease
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normochronic
normocytic mild anisocytosis mild poikilocytosis |
anemia of chronic disease
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increased homocystein
increased methylmalonic acid MCV increased |
B12 deficiency leading to megaloblastic anemia
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patient took methotrexate and has anemia
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megaloblastic anemia
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oval macrocyte
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megaloblastic anemia
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hypersegmented neutrophils
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megaloblastic anemia
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cabot ring
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megaloblastic anemia
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pancytopenia
low retics elevated MCV elevated LDH serum Fe normal or elevated homocsteine elevated |
megaloblastic anemia
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giant pronormoblasts with multiple nucleoli
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megaloblastic anemia
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achlorhydria
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pernicious anemia
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increased hemoglobin A2
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beta thalassemia trait
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no hemoglobin A1 or A2
100% HgF |
HPFH thalassemia
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increased HgF
some Hgb A1 mild anemia |
Corfu Thalassemia
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mild anemia
moderate increase in Hgf no A1, no A2 |
delta beta thalassemia
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low hepcidin
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beta thalassemia
this is a problem because it means that iron absorption isn't regulated and this enables iron overload in thalassemia patients |
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microcytosis and not much else
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alpha thalassemia trait
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hemoglobin is made of 4 beta chains
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HbH form of alpha thalassemia in which there is only one alpha allele
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RBCs with HgH precipitates
macrocytosis |
acquire alpha thalassemia called ATMDS.
caution, becuase it can be a precursor to acute leukemia |
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mental retardation
alpha thalassemia |
ATRX complex
(X linked) |
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microcytosis
hypochromia target cells extensive changes in size and shape |
Thalassemia
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increased Hemoglobin F
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thalassemia
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hematuria
hyposthenuria |
sickle cell trait (AS)
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African
moderate anemia bones and eye affected |
hemoglobin C disorders
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mild anemia with two mutations
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SA - sickle beta+ thalassemia
(a little A dilutes out the S) |
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microcytic, severe anemia
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SBO Sickle Beta-0 thalassemia
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Saudia Arabian
mild sickle cell disease |
HPFH
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Southeast Asian with a sickle cell disease
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Hemoglobin E disorder
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petechiaa
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platelet disorder
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bleeding in mucous membrane
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platelet disorder
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bleeding in deep tissue
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coagulation abnormality
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immediate time of onset of bleeding
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platelet disorder
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delayed time of onset of bleeding
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coagulation abnormality
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ecchymoses/hematomas
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platelet disorder and coagulation abnormality
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unusually large platelets
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Bernard Soulier disease
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increased aPTT and bleeding time
decreased vWF activity level decreased Factor VIII antigen and activity Ristocetin-induced platelet aggregation |
vW disease
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ashkenazi jew with mild bleeding d/o
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Factor XI deficiency
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hospitalized patient
not eating well on antibiotics PT goes up |
acquired Vitamin K deficiency
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increased PT, APTT, TT
alcoholic |
liver disease causing acquired clotting disorder
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Israeli family with no history of thrombosis
no family hx neonatal purpura fulminans in offspring increased thrombin generation |
Recessive anti-coagulant protein deficiency
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increased clotting
Protein C can't prolong aPTT increased risk of venous thromboemboli |
Activated Protein C Resistance
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thromboembolism in pregnancy
woman of swedish descent |
Prothrombin G20210 mutation hypercoagulability (mechanism not known)
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woman with lupus
2 miscarriages in the 2nd trimester has had an arterial thrombus had a false +RPR |
anticardiolipin antibody syndrome
(which is a procoagulant disorder!) |
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increased D dimers
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acute DIC and its defibrination
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